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Archive for January, 2012

To John Paul

Today marks your 5th day in the hospital.

Yesterday, while we were doing our usual nursing rounds, I couldn’t help but smile at the sight of your condition. You were a far cry from the state that I had admitted you. I could still remember how you looked that day: pale and paper-thin. And even if the ER nurse didn’t mention your diagnosis, I could  tell you were suffering from Pulmonary Tuberculosis. You got it from your mother, I heard. It confounded me that it was your Aunt and Uncle who brought you to the hospital. But it only took a few minutes of nurse-patient interaction to find out both your parents are already dead.

I wanted to say “I’m sorry for your loss, John Paul.” But I kept silent. Because you know what, it isn’t really your loss..but your parents’ loss for not knowing such a wonderful son like you. It didn’t take five days for me to conclude that because since our first meeting, you have already shown me admirable traits that not all kids of your generation possess.

You never fail to say “thank you po.” In fact, you were so polite you would often mistakenly call me “Doc.” And you would give me that sheepish smile every time I would  remind you that I am your nurse, not your doctor. I remember, on your first night in the hospital, you were having a fever of 39.7 C. If I didn’t see you shivering in your sleep I wouldn’t have noticed. Because that’s how you were, you would rather endure the discomfort than cause it yourself.

I searched for your doctor to prescribe you with some anti-pyretic drug. But unfortunately that night, your doctor was much needed in the other department. And so I had to do what a registered nurse wasn’t really allowed to do. I calculated the drug dosage base on your body weight and had given you IV paracetamol without a doctor’s order. But don’t worry John Paul because as soon as your doctor came, I informed her of your condition and she had prescribed the same medication with the exact dosage that I had given you.

You had three drugs prescribed for you: Oxacillin, Ceftazadime, and Streptomycin. All these require a skin test prior to the actual giving to check if you were allergic to any of the drugs. Before doing that, I explained how you were going to experience a bit of pain in the process. I would usually do that to prepare the patient for the great discomfort  they’re going to feel, which isn’t really effective considering how kids loathe injectables. But you were different, John Paul. Not a single ache was heard from your mouth nor a slight movement from your body. Not only were you kind, but you were also brave.

Tonight, as I am going on my night duty, I am not sure if I’d still see you. I would have guessed your doctor might have ordered a discharge for you in the morning. But nevertheless, I would be happy. Not because you have lessened my patient count tonight, but because I know all is well with you. You deserve an enjoyable childhood beyond the walls of this hospital..so go forth John Paul. And never come back.

Sincerely yours,

Your Pedia Nurse.

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To Rachel

I held you in my arms at 2:35 am. As soon as the ER nurse called your admission, I began my distress. “For standby intubation,” –these are the words most dreaded by any nurse who knows how to read beyond doctor’s orders.  In medical world, that basically translates into “you have a few hours to live.”

Yet I stood there, hoping you were a miracle.

You were breathing heavily, too rapidly, and the oxygen support didn’t seem to be of much sustenance at all. In fact, your O2 Sat was 9 digits low. Again, I began my uneasiness. I laid you under close watch service, on the first bed where I could see you from the nurse’s station.

I’m sorry you had to share a bed with another patient. I couldn’t risk placing you on the farther side of the ward, in case…you know, something bad happens. You need to be attended every hour. You were high-maintenance, and though I had 21 other patients last night, you pretty much consumed my 8-hour shift.

Your chart wasn’t modest of your condition. It read: Pneumonia very severe s/p colostomy 2010, Down Syndrome.  You had, not just one, not just two, but three diagnoses. First problem was that your airway was clogged with mucus, which explains the little oxygen circulating in your body. Second, you weren’t blessed with an orifice on your rectum so in 2010, they had attached a “poo-bag” for you. That, by the way, increased your risk for infection. And third, you were born with chromosomal aberration.

Am I now sounding too technical for you? Don’t worry. You don’t have to understand these things at such a young age. All you had to do was fight your battle. You carry a deadweight much heavier than you can endure but you lay there with your eyes closed, looking tranquil in sleep. Were you dreaming of heaven, Rachel? I guess I will never know.

Your mother was kind, and so is your grandmother. They amenably did what I asked them to do and they never left your side. But at around 4 in the morning, your vitals started deteriorating. Your O2 Sat fluctuated from 90 to 64 to 85. Your heart was pounding for the lack of oxygenated blood, and on top of that, you were having a hyperthermia.

Nebulization every two hours began and we suctioned your secretions after that. Did you feel any bettering? Your vitals expressed no, but only you can best judge what you had felt. Just one more hour and you will be surviving my shift. I put away the emergency cart since you didn’t look like you were going to have a cardiac arrest within my duty. But in the midst of the endorsement, 30 minutes passed my shift, your mother came running and said something I could barely understand. But no words needed for that, because as soon as I saw her face, I knew. I jumped on my feet, grabbed the stethoscope and rushed your way.

When I reached you Rachel, you were no longer gasping for air. I placed the stet on your chest and heard nothing. The pulse oximeter now reads 0 0 – negative for oxygen and negative for pulse rate. I immediately called your physician and while on his way, I grabbed the emergency cart that I just put away. I didn’t notice how malnourished you were until we had to stripped you off your clothing and do chest compression. I could do a mental count, not only of your ribs, but as well as your intercoastal spaces. That’s how skeletal you were. I injected Epi in your system to start the heart pumping, but not even a flutter could be heard. Your O2 was now on full blast, but we were the ones doing the breathing for you.

Last try, another dose of Epi was ordered. But you were still a flat line.

At 7:45 am Rachel, your doctor pronounced you dead. I started returning everything that I had put out for you: the pulse oximeter, the nebulizer, the suction machine, the E-cart, and the O2 tank. None of these equipment were strong enough to fight a much bigger force.

 You fought a hard battle, Rachel. Now it’s time for you to continue living in your dreams.

Sincerely yours,

Your Pedia Nurse

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